<%@ page language="java" contentType="text/html; charset=UTF-8"
    pageEncoding="UTF-8"%>
<%@ taglib prefix="c" uri="http://java.sun.com/jsp/jstl/core" %>
<%
String path = request.getContextPath();
String basePath = request.getScheme()+"://"+request.getServerName()+":"+request.getServerPort()+path+"/";
%>
<!DOCTYPE html>
<html lang="en">
<base href="<%=basePath%>">
<head>
    <meta charset="UTF-8">
    <title>Document</title>
    <link rel="stylesheet" href="css/fileImage.css" />
</head>

<body>
	<div style="padding:15px 30px">
		<form id="patientForm" method="post" enctype="multipart/form-data" >
		<div style="float: left; width: 48%;">
			<input type="hidden" name="id" />
			<input type="hidden" name="image" />
	        <div style="margin-bottom:18px">
	            <input class="easyui-textbox" id="identification" name="identification" style="width:100%" data-options="label:'标识号:',required:true,missingMessage:'标识号必须填写'">
	        </div>
	        <div style="margin-bottom:18px">
	            <input class="easyui-textbox" id="name" name="name" style="width:100%" data-options="label:'姓名:',required:true,missingMessage:'名称必须填写'">
	        </div>
	        <div style="margin-bottom:18px">
	        	<label class="textbox-label textbox-label-left" for="_easyui_textbox_input2" style="text-align: left; height: 26px; line-height: 26px;">性别:</label>
	            
	            <input type="radio" name="gender" id="" value="1" checked="checked" />男
	            <input type="radio" name="gender" id="" value="0" />女
	            
	        </div>
			<div style="margin-bottom:18px">
				<input class="easyui-numberbox" name="age" data-options="label:'年龄:',labelPosition:'left',min:0,max:200,required:true,missingMessage:'年龄必须输入(1~200)'" style="width:100%;">
			</div>
		    <div style="margin-bottom:18px">
		        <input class="easyui-datebox" name="birthday" label="出生日期:" labelPosition="left" style="width:100%;">
		    </div>
		    <div style="margin-bottom:18px">
			    <label class="textbox-label textbox-label-left" for="" style="text-align: left; height: 26px; line-height: 26px;">头像:</label>
	            <a href="javaScript:void(0)" class="a-upload">
	                    <input type="file" name="photo" id="myFile" multiple="multiple"  class="fileImage" />
	                    <img id="preview" src="" width="100px" height="100px" alt="">
	            </a>
		  	</div>
		</div>
		<div style="float: right; width: 48%;">
			<div style="margin-bottom:18px">
	            <input class="easyui-textbox" id="phone" name="phone" style="width:100%" data-options="label:'联系电话:',required:true,missingMessage:'联系电话必须填写'">
	        </div>
	        <div style="margin-bottom:18px">
	        	<label class="textbox-label textbox-label-left" for="" style="text-align: left; height: 26px; line-height: 26px;">地址:</label>
	        	<label for="">省:</label>
			    <input class="easyui-combobox" id="sheng" name="" style="width:20%;" data-options=" 
			      url:'address/selectByTypeId', 
			      method:'get', 
			      valueField:'id', 
			      textField:'name', 
			      panelheight:'auto',
			    ">
	        	<label for="">市:</label>
			    <input class="easyui-combobox" id="shi" name="" style="width:20%;" data-options=" 
			      url:'', 
			      method:'get', 
			      valueField:'id', 
			      textField:'name', 
			      panelheight:'auto',
			    ">
	        	<label for="">区:</label>
			    <input class="easyui-combobox" id="qu" name="address.id" style="width:20%;" data-options=" 
			      url:'', 
			      method:'get', 
			      valueField:'id', 
			      textField:'name', 
			      panelheight:'auto',
			    ">
		    </div>
	        <div style="margin-bottom:18px">
	            <input class="easyui-textbox" name="detailed" style="width:100%" labelposition="left"  data-options="label:'详细地址:'">
	        </div>
	        <div style="margin-bottom:18px">
	            <input class="easyui-textbox" id="email" name="email" style="width:100%" data-options="label:'邮箱:',required:true,missingMessage:'邮箱必须填写'">
	        </div>
	        <div style="margin-bottom:18px">
	            <input class="easyui-textbox" id="money" value="0" name="money" style="width:100%" labelposition="left" data-options="label:'账户余额:'">
	        </div>
 			<div style="margin-bottom:18px">
	            <input class="easyui-textbox" id="idCard" name="idCard" style="width:100%" data-options="label:'身份证号:',required:true,missingMessage:'身份证号必须填写'">
	        </div>
		</div>
		</form>
	</div>
    <script type="text/javascript" src="js/fileImage.js"></script>
	<script type="text/javascript" src="js/linkage.js"></script>
</body>
</html>